Countries need healthy populations to develop. But for a long time, the African tale has been one of expectant mothers dying because they reside miles away from the nearest health facility. Stories of children dying even after they get to health facilities due to the unavailability of drugs or few medical professionals to attend to so many of them. Even those residing in urban centers – especially those living in informal settlements – still have it rough. Public health facilities are often overcrowded and poorly equipped with resources to cater to the growing demands for health services.
Reaching these populations with health services by the year 2030 is one of the targets of the Sustainable Development Goals (SDGs). Among the goals is one that aims to eradicate malaria, tuberculosis, and AIDS, among other diseases. Another one targets ending child mortality. The magnitude of these ambitions calls for serious interventions and commitment from both political and industry leaders globally.
Of all the regions of the world, it is perhaps Sub-Saharan Africa where the pursuit of these ambitions should be most fervent. Alongside the mega infrastructure projects, health should be among top priorities considering the poor performance in many global health indicators.
Africa, home to 16% of the global population, bears 23% of the global disease burden according to the Global Health Data Exchange. A staggering 68% of HIV/AIDs victims being from Africa. These grim statistics depict the urgency and seriousness with which African governments and players in the health sector need to address the growing health gaps.
An Underfunded health sector in Africa
Yet the region continues to invest dismally in its health. In 2015, Africa’s expenditure on health accounted for just 1% of the total global expenditure (Compared to 10% for the rest of the world) in per capita terms. This means that, for African countries to at least measure up to the rest of the world, investment in the health sector has to increase tenfold. Targets will go even higher, considering that the world needs an excess of $370 billion to attain the health SDG targets.
Realization of the prevailing health crisis and the need to achieve Universal Health Care in Africa happened years ago resulting in the Abuja Declaration (2001). African governments committed to spending at least 15% of their annual national budgets on improving the health sector. Close to two decades later, only a handful of countries have achieved this target – Rwanda, Burkina Faso, Niger, Zambia, Botswana, and Malawi. To be more vivid, in more than 60% of the countries in Africa, the proportion of the health budget to the national budget falls below 10%. Kenya’s health budget, for instance, has averaged only about 8.5% of the national budget over the last five financial years.
This points to under prioritization of the health sector in Sub-Sahara African counties and an indictment on the focus and priorities of African leaders.
Out of Pocket Expenditures and Donor Funding
While the growth in GDP of most African countries has resulted in increased health budgets over the years, out-of-pocket expenditures and donor funding continue to account for the bigger portion of health expenditure in Sub Saharan Africa. Governments contribute only 44% of health expenditures in the region. Out-of-pocket expenditure account for 37% with donors covering the remaining 19%.
This spending weighs heavily on the pockets of Africans, considering Africa’s high poverty index (41%). A significant proportion of the African population – up to 38% - either delay or forgo getting health care services due to their unaffordability. The under-equipment of health facilities in the region makes things worse. Donor funding also remains limited, intermittent and increasingly delivered based on economic development priorities of donor countries rather than established needs in recipient countries.
Reshaping the narrative
To achieve universal healthcare coverage, Africa needs to significantly increase spending on health care service delivery beyond the 15% commitment made during the Abuja declaration. Beyond that, all the stakeholders in Africa’s health sector need to find localized solutions to address the unique needs of particular regions.
The beautiful thing is that the process has already started. Rwanda, for instance, has been implementing the use of drones for the delivery of medical supplies. Since its inception in 2016, the project has undergone changes and improvements for increased efficiency. Ghana is also replicating this technology.
In Kenya, Camel Clinics are used to make medical care accessible to Samburu – a significantly underdeveloped area. In Turkana, motorbike ambulances have brought hope for residents. They make it possible for health personnel to access people in the remotest corners of this underdeveloped county. The same concept is being implemented in Tana River County and rural areas in western Uganda.
In Malawi, e-innovation healthcare service delivery has proved effective in ensuring people in rural areas access medical services. They only need a mobile phone that can send and receive messages. Through it, they get reminders when to take their medication or connect to health care providers.
These localized solutions help address the dynamic and unique healthcare needs of the African population. If scaled up, they will help improve accessibility and efficiency in Africa’s health care system.
Africa governments must now rise to the occasion and be at the forefront in enhancing these solutions by putting the money where it is needed most. That translates to re-evaluating the region’s health financing strategy and increasing health sector funding. Beyond prioritizing health care and having an effective health financing strategy, stringent measures should be put in place to ensure the effective utilization of resources channeled to the health sector.
The continent’s health sector lags far compared to the standards set by the rest of the world. Moving forward, beyond measuring up to other continents, Africa needs to be bold and committed to attaining the best possible health standards. It is only through that path that it will be able to reshape its health narrative and be better prepared to handle the ever-growing demand for quality health services in the region.